Haryana

StateCommission

A/583/2015

NATIONAL INSURANCE CO.LTD. - Complainant(s)

Versus

SUMITRA DEVI - Opp.Party(s)

NITIN GUPTA

26 Apr 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :      583 of 2015

Date of Institution:      13.07.2015

Date of Decision :       26.04.2016

 

The Branch Manager, National Insurance Company Limited, Branch Office, 65, Navyug Market, Ghaziabad (UP)-201001 through its Branch Office, G.T. Road, Panipat.

Now represented through its duly authorised signatory of Regional Office-II, National Insurance Company Limited, SCO No.337-340, Sector 35-B, Chandigarh.

                                      Appellant/Opposite Party

Versus

 

Mrs. Sumitra Devi w/o Sh. Jai Kishan, Resident of Gali No.4, Vikas Nagar, near NFL Colony, Panipat, Haryana.

                                      Respondent

 

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

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member   

 

Present:               Shri Nitin Gupta, Advocate for appellant.

                             Shri S.S. Kharb, Advocate for respondent.

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

National Insurance Company Limited (for short ‘the Insurance Company’)-Opposite Party, is in appeal against the order dated May 18^th, 2015 passed by District Consumer Disputes Redressal Forum, Panipat (for short ‘the District Forum’) in Complaint No.20 of 2014.

2.      Sunny-since deceased (hereinafter referred to as ‘the insured’),  son of Smt. Sumitra Devi-complainant/respondent, purchased a Group Personal Accident Insurance Policy (Annexure A-1) from the Insurance Company on March 11^th, 2013, covering risk for the sum insured of Rs.4,00,000/-, out of which 80%, that is, Rs.3,20,000/-  was towards Personal Accident Section and 20%, that is, Rs.80,000/, towards hospitalization. The insured died on August 30^th, 2013 in an accident by fall from stairs. He was taken to Malik Hospital, Gohana Road, Panipat, where he was declared ‘brought dead’. Post Mortem examination was not carried out. However, Daily Diary Report (Annexure A-4) was lodged with the Police. The complainant being mother, lodged claim with the Insurance Company which was repudiated. Hence, complaint under Section 12 of the Consumer Protection Act, 1986 was filed.

3.      The Insurance Company-opposite party contested complaint stating that Sunny (the insured) did not die on account of accident and that no Post Mortem Report (PMR) was produced and in the absence of which it could not be determined that the cause of death was accident. The other allegations were denied.

4.      After evaluating the pleadings and evidence of the parties, the District Forum allowed the complaint and directed the Insurance Company to pay Rs.4.00 lacs, that is, the sum insured to the complainant alongwith interest @ 9% per annum from the date of filing of the complaint till realization and Rs.2200/- litigation expenses.

5.      Learned counsel for the Insurance Company/appellant while assailing the order of the District Forum referred to the letter intimating the death, wherein it was mentioned that the insured had fallen from the stairs and suffered injuries. He was taken to Malik Hospital where he was declared dead. Thus, it was not an accidental death. Learned counsel also referred to the certificate Annexure A-6) issued from Malik Hospital, Panipat to the same effect.

6.      The issuance of the insurance policy has not been denied by the appellant/Insurance Company. The sum insured was Rs.4.00 lacs out of which 80% i.e. Rs.3,20,000/- covered the Personal Accident and 20%, i.e. Rs.80,000/-, towards hospitalization. There was no hospitalization, as per Certificate Annexure A-6, issued by Dr. Partap Malik, Malik Hospital, Panipat. Besides, even in the Claim Form (Annexure A-5) no reference has been made of hospitalization. Merely because Post Mortem examination was not conducted, cannot be a ground to deny the death benefit to the complainant. However, the District Forum has wrongly allowed Rs.4.00 lacs, that is, the total sum insured, as the coverage on account of personal accident was only Rs.3,20,000/- which the Insurance Company is liable to pay to the complainant.

7.      In view of the above, the Insurance Company is directed to pay Rs.3,20,000/- to the complainant instead of Rs.4,00,000/-. Rest of the order is maintained.

8.      The impugned order is modified in the manner indicated above and the appeal stands disposed of.

9.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

Announced 26.04.2016

(Diwan Singh Chauhan) Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President

CL