Haryana

StateCommission

A/169/2015

ORIENTAL INSURANCE CO. - Complainant(s)

Versus

SULAKSHNA AND ANOTHER - Opp.Party(s)

D.C.KUMAR

13 Jul 2015

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :      169 of 2015

Date of Institution:      20.02.2015

Date of Decision :       13.07.2015

 

The Oriental Insurance Company Limited, Divisional Office Company Limited Rohtak through Shri S.P. Singh, Regional Manager, The Oriental Insurance Company Limited, Regional office, LIC Building, II Floor, Jagadhri Road, Ambala Cantt.

                                      Appellant-Opposite Party No.1

Versus

 

1.      Sulakshna w/o late Shiv Charan, Resident of Village Garhi Sampla, District Rohtak.

Respondent-Complainant

 

2.      Douphin Touch Network (P) Limited Registered Office A-212/C-304, Tirupati Plaza Street No.1, Vikas Marg, Shakarpur Delhi-110092 through its Manager/Incharge (service to be effected through Branch Manager Old D.C. Road,  Bhagat Pura Chowk, Sonepat).

                                      Respondent-Opposite Party No.2

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member                                                                                                                                         

Present:               Shri D.C. Kumar, Advocate for appellant.

Shri Abhishek Verma, Advocate for respondent No.1.

None for respondent No.2.

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

The Oriental Insurance Company Limited (for short ‘the Insurance Company’)-Opposite Party No.1, is in appeal against the order dated January 13^th, 2015, passed by District Consumer Disputes Redressal Forum (for short ‘District Forum’), Rohtak.

2.      Shiv Charan (since deceased)-husband of Sulakshna-complainant (respondent No.1 herein) purchased ‘Nagriksuraksha Group Policy for Rs.5,00,000/- from the Insurance Company. He paid Rs.4,000/- as premium with Dauphin Touch Network (P) Ltd –Opposite Party No.2 on December 31^st, 2006 vide Application Acknowledgement  Registration No.0000000491 and receipt Exhibit P-1.  Cover Note Exhibits P-2 and P-3 were issued by the opposite parties. The insured Shiv Charan met with an accident on February 17^th, 2007 and died. F.I.R. No.48 dated February 17^th, 2007 (Exhibit R-3) was lodged in Police Station, Sampla District Rohtak. Post Mortem Examination of the deceased was conducted vide Post Mortem Report (Exhibit R-4). Death Certificate Exhibit R-5 was issued by Registrar Births & Deaths, CHC Sampla. The complainant being widow of the deceased-insured, lodged claim with the Insurance Company but the same was repudiated vide letter Exhibit R-12.

3.      The opposite parties contested complaint by filing their respective replies. The opposite party No.1 –the Insurance Company stated that Group Nagriksuraksha Policy was issued from March 9^th, 2007 to March 8^th, 2008 in favour of Douphin Touch Network (P) Limited-Opposite Party No.2, vide which 12526 persons were insured as per list submitted by opposite party No.2. Group Personal Accident Policy No.271700/48/2007/29339 was issued on March 9^th, 2007 in favour of opposite party No.2. It was submitted that the risk of deceased Shiv Charan was not covered on the date of accident as the death took place on February 17^th, 2007 while the policy was issued on March 9^th, 2007. It was submitted that premium was received on March 9^th, 2007 and accordingly the policy was issued thereafter. Justifying their stand, it was prayed that the complaint merited dismissal.

4.      Opposite Party No.2 - Douphin Touch Network Private Limited stated that Shiv Charan-deceased, acquired distributorship of the opposite party No.2, a marketing company, for purchase of products and to sell the same on commission basis. The Insurance Policy was issued covering life risk of Shiv Charan at Delhi. The opposite party No.2 denied having received any premium stating that Shiv Charan had become business distributor by paying Rs.4,000/- and as per the scheme launched by the opposite party No.2, the Insurance Policy was gifted to for the welfare of the business distributor Shiv Charan free of cost. The other allegations were denied.

5.      After evaluating the pleadings of the parties and the evidence available on the record, the District Forum vide impugned order accepted complaint issuing direction as under:-

“….the opposite party No.1 is directed to pay the sum insured of policy No.270000292979 amounting to Rs.250000 (Rupees two lac fifty thousand only) and policy No.270000292978 amounting to Rs.200000/- Rupees two lac only) along with interest @ 9% p.a. from the date of filing the present complaint i.e. 04.05.2011 till its realization respectively and shall also pay a sum of Rs.2200/- (Rupees two thousand two hundred only) as litigation expenses to the complainant maximum within one month from the date of decision failing which the awarded amount shall fetch interest @ 12% p.a. from the date of decision.”

 6.     While assailing the order of the District Forum, learned counsel for the appellant referred to cover notes (Exhibit P-2 and P-3) stating that since the policy commenced from March 9^th, 2007 and the death took place on February 17^th, 2007, therefore, the deceased was not covered under the policy on the date of his death. In support reference was made to the Certificate dated December 1^st, 2005 (Exhibit PW5) issued by the Insurance Company thereby certifying that they had undertaken to issue Group Insurance Policy by virtue of a contract entered into between the Insurance Company and Douphin Touch Network Private Limited-Opposite Party No.2. Pamphlet (Exhibit PW-6) has been placed on the file containing a clause that the introducer would get the form and the proposal form filled up and Rs.4,000/- would be deposited with the company against receipt. An identity card would be issued within 30 days and the Insurance Policy would be received within 60 days with further assurance that the policy risk would commence 15 days after the issuance of receipt. The receipt is on the file vide which Rs.4,000/- was paid. The receipt is dated December dated 31^st, 2006 and in terms of the above mentioned clause of the pamphlet, the risk was to commence 15 days thereafter. Meaning thereby that the risk would commence from January 15^th, 2007. The receipt finds the distributor ID No.190000157691 and same number finds mention in the Cover Notes Exhibit P-2 and P-3.

7.      Once the payment has been made on December 31^st, 2006 and the risk was to commence 15 days thereafter, that is, from January 15^th, 2007, if the Insurance Company did not issue the policy, they cannot avoid their liability for their own fault. The District Forum has rightly held the appellant-Insurance Company deficient in service and allowed the complaint.

8.      In view of the above, the order passed by the District Forum requires no interference. Hence, the appeal is dismissed.

9.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the respondent No.1 (complainant) against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

Announced 13.07.2015

(Diwan Singh Chauhan) Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President

CL