Punjab

Rupnagar

CC/21/3

Harcharan Kaur - Complainant(s)

Versus

Star Health and Allied Insurance Co. Ltd. - Opp.Party(s)

sh. Ramesh Kumar Kaushal, Adv.

10 Oct 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION `ROPAR

 

                                  Consumer Complaint No.03of 2021

                               Date of institution: 01.01.2021

                               Date of Decision: 10.10.2022

1. Harcharan Kaur aged about 47 years widow of Rajinder Singh
2. Parbhjot Kaur aged about 24 years daughter of late Sh. Rajinder Singh
3. Monika aged about 22 years daughter of late Sh. Rajinder Singh
4. Navneet Kaur aged about 20 years daughter of late Sh. Rajinder Singh
5. Harmanjot Singh aged about 14 years son of Late. Sh. Rajinder Singh 

Residents of House No.412, Ward No.4, Morinda Tehsil Morinda, District Rupnagar

…….Complainants

Versus

1. Rajinder Kumar agent of Star Health and Allied Insurance Company Limited, C/o Ankit Mobiles Railway Road, Opposite Dhiman Clinic, Morinda, Tehsil Morinda, District Rupnagar
2. Star Health and Allied Insurance Company Limited, Branch SCO 130/131, 4^th Floor, Sector 34-A, Chandigarh now shifted at SCO No.5A, Second Floor, Sector 7, Madhya Marg, Chandigarh through its Branch Manager      

                                       ……..Opposite Parties

QUORUM:     

HON’BLE MR.RANJIT SINGH, PRESIDENT.

HON’BLE MRS.RANVIR KAUR, MEMBER

PRESENT:-

Sh.Ramesh Kumar Kaushal, Adv. counsel for complainant

Complaint not admitted against OP1

Sh. Amit Gupta, Adv. for OP2

 

ORDER

SH. RANJIT SINGH, PRESIDENT

The present order of ours will dispose of the above complaint filed under Consumer Protection Act, by the complainantagainst the Opposite Parties on the ground that the complainant No.1 is wife of Rajinder Singh since decased and nominee in the policy and the Rajinder Singh died left behind Harcharan Kaur, Prabhjot Kaur, Monika and Navneet Kaur and Harmanjiot Singh as his legal heirs. Rajinder Singh since deceased had purchased the accident care individual insurance policy, unique identification No.IRDAI/HLT/P-P/V.III/134/2017-18 on 26.09.2018 from the OP2 through OP1 bearing policy No.P/161113/02/2019/000114 for a sum of Rs.50,000/- and the said policy was valid from 27.09.2018 to 26.09.2019. Previously Rajinder Singh since deceased had purchased accidental care individual insurance policy from the OP in the year 2018.Rajinder Singh since deceased was running a dryclean shop at near Ramgarhian Gurudwara Morinda. On 19.9.2018, Rajinder Singh was bitten by snake and he was taken to Civil Hospital, Morinda, where after first aid he was referred to PGI, Chandigarh and after treatment he was discharged from PGI, Chandigarh. On 30.09.2018,Rajinder Singh was again bitten by a snake and he was taken to Civil Hospital, Morinda, and after first aid h was admitted to PGI Chandigarh, where whole body cloating test done by doctors of PGI, Chandigarh and he was remain admitted from 30.09.2018 to 02.10.2018. It is further alleged that on 21.10.2018, Rajinder Singh was again bitten third time by snake and he was admitted to PGI, Chandigarh where he had died on the same day because of snake bite at PGI, Chandigarh. DDR in this regard has been registered by the police of PS Morinda vide DDR No.010 dated 19.12.2018.The complainant No.1 visited the office of Opposite party and requested them to make the payment of sum assured of Rs.50,00,000/- mentioned in the insurance policy, but the OP put the matter on one pretext or the other and finally on 29.03.2019, the Op repudiated the claim of the complainant No.1 with false grounds that Rajinder Singh dies due to late reaction of earlier snake bite. Thus, alleging deficiency in service on the part of O.Ps. the complainant has sought the following relief:-

1. To pay the claim amount of Rs.50,00,000/- along with interest @ 18% per annum.
2. To pay Rs.5,00,000/- as compensation on account of physical, mental harassment along with litigation expenses.

The complaint of the CC is signed and also verified.

2.             In reply, the O.Ps. has taking preliminary objection; that the husband of the complainant has approached the OP2 for getting the insurance cover under accident care individual insurance policy on 26.9.2018 for the purpose of covering self for a sum of Rs.50,00,000/- w.e.f. 27.09.2018 to 26.09.2019 after concealing about the earlier snake bite on 19.9.2018. The said insurance cover being a contact both the parties are strictly bound by its terms and conditions and neither parties can traverse beyond the scope of the same; that during the currency of the policy, the complainant had intimated the claim against accidental death of Rajinder Singh on account of snake bite and the said claim was duly processed by the company in accordance with the terms and condition of the policy, while going through the documents submitted by the complainant, it was found that deceased has sufferd first snake bite on 19.9.2018 which is prior to the inception of the subject policy. The cause of death is due to late reaction of earlier snake bite. The deceased had not disclosed about the earlier snake bite at the time of proposing the insurance with the company. As per the OPD Card No.2018-0574-5156 dated 19.2.2018 issued by internal medicine, PGI, Chandigarh, it is evidence, now late. Rajinder Singh was admitted for once snake bite at 7.50 PM on 19.9.2018. The complainant has also alleged about the snake bite on 30.09.2018. As per the medical certificate of cause of death issued by PGI, Chandigarh  with regard to emergency OPD admission of Rajinder Singh on 21.10.2018 at 3.35 PM with CR No.2018 0574 5156 with admission No.3734/DF, the cause of death is mentioned as refractory septic shock as immediate cause and antecedent cause is snake bite (twice). The manner of death is mentioned is natural. Thus, the claim of the complainant is not maintainable as on account of reasons mentioned above, as the death of Rajinder Singh is not accidental but natural on account of septic Shock. Thus, the claim of the complainant was rightly repudiated vide letter dated 28.3.2019. The DDR has been lodged at a belated stage in order to distort the facts by conversion of natural death to accidental death and as such the same is liable to be ignored. Moreover, no postmortem of the deceased was conducted by the complainant which could have ascertained the actual cause of death. On merits, it is stated that there is no deficiency in service on the part of the OPs and prayed for dismissal of the complaint.

3.             The learned counsel for the complainant has tendered into evidence his affidavit Ex.CW1/A along with documents Ex.C1 to Ex.C9 and closed the evidence. On the other hand, the learned counsel for the OP2. has tendered affidavit of Sh. PC Tripathi, Zonal Manager, Ex.OP1, affidavit of Chander Shekhar Sharma Ex.OP2 along with documents Ex.OP3 to Ex.OP16 and closed the evidence. 

4.             We have heard learned counsel for the parties and have gone through the file, carefully and minutely.

5.             It is pertinent to important to mention here that the after perusing the summoning the record from the PGIMER, Chandigarh, it is clear that the husband of the complainant was died due to refractory septic shock. After going through the documents, it reveals that deceased has suffered first snake bite on 19.9.2018 which is prior to the policy. The cause of death is due to later reaction of earlier snake bite. The deceased has not disclosed about the earlier snake bite at the time of proposing the insurance with the company.  Therefore, the complainant is not entitled any relief. 

9.             In view of discussion made above, we dismissed the complaint.  Free certified copies of this order be sent to the parties, as per rules. The file be sent to the Record Room.

Announced

October 10, 2022

(Ranjit Singh)

President

                                               

(Ranvir Kaur)

Member